In the United States obesity continues to be a growing issue in the adult population, which is compounded by the fact that many people have had antidepressant therapy at some point in their lives. Health problems such as metabolic syndrome, diabetes, skeleton/joint issues and more can stem from obesity. These comorbid health care problems can increase the costs at the state and federal levels. This paper will examine obesity and its relation to antidepressant therapy in depressed adults that are obese or endeavoring to avoid further weight gain. Research indicates that antidepressant therapies have shown a greater propensity towards weight gain, though few research studies show weight loss.

Intervention: 10 minutes of nutritional counseling during office visits. Setting: Family psychiatric clinic in the southwest of the United States.

Methods: Data collection process: Depressed adults on antidepressant therapies were randomly selected.

Instrumentation: Weight scale, National Literacy Scale, pamphlet (for teaching) and height scale. Data collected was at baseline, 4 weeks and 8 weeks.

Outcomes: 14 Participants agreed to the project, 10 completed to the 4-week mark and 4 finished the project to the 8-week mark. 10 female participants and 4 male participants. The remaining 4 participants showed 1.6% reduction in body mass index, which correlated with an increase in nutritional learning from baseline to 8-weeks.

Recommendations: Nutritional counseling is a non-pharmacological intervention for achieving and a desired weight, which has shown positive results in varying populations and clinical situations.

Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions, treatment failure, patient dissatisfaction, and lack of treatment control. The associated practice challenges have led to the following PICOT question. In persons with mental health issues receiving care at an outpatient mental health clinic, does engaging in mindfulness practice versus no mindfulness practice change polypharmacy use over a 3-month period?

The project purpose was to evaluate the effectiveness of Insight Timer mobile mindfulness app at helping patients self-manage distressing symptoms and reduce polypharmacy. Over three weeks, mental health clinic nurse practitioners (NPs) voluntarily recruited patients (n=12) over age 18 using as needed prescriptions (PRNs), and agreed to use Insight Timer mobile mindfulness app for adjunct symptom management. Consenting participants downloaded the mobile app, and completed a brief questionnaire measuring PRN use at the start of app use, and PRN use at their next visit. A Wilcoxon signed-rank test indicated a 10-week mindfulness app trial did not significantly lower total PRN doses compared with pre-app dosing (Z = -.534, p = .593). Paired t-tests revealed no significant change in pre (M = 65.17, SD = 28.64) versus post (M = 67.75, SD = 20.22) OQ45 life functionality results (t(11) = -.420, p = .683) (d = .121) as a result of app use.

Clinically relevant results illustrated 83.33% of participants taking greater than nine PRN doses over the study period used the app six times or more in place of medication. High PRN users employed the app frequently in place of medication regardless of total PRN doses taken. Practice implications and sustainability recommendations include incorporating mobile app use in treatment plans for high PRN users and educating NP’s on the tangible benefits of mindfulness apps in reducing polypharmacy and easing symptom distress on an ongoing basis.
Keywords: mindfulness, mhealth, mobile apps, mobile smart phone, online, RCT, behavior change, polypharmacy.